Medicaid Claims Operations Manager

General Dynamics Information Technology; Montgomery (AL); Hybrid; USD 105,000 - 145,000; Full time

Job summary

General Dynamics Information Technology (GDIT) seeks a Claims Operations Manager to oversee Medicaid Enterprise Systems (MES) claims processing operations within the Fiscal Agent Operations function. The role focuses on processing, adjudication, and resolution of Medicaid claims with strict adherence to SLAs and regulations.

You will lead a team to ensure accuracy, timeliness, and compliance while collaborating with leadership on strategic initiatives and performance improvements.

Qualifications

• Bachelor’s degree in a related technical, scientific, business, health or related discipline.
• 5+ years of related experience.
• Experience leading Medicaid operations and provider enrollment.
• Strong communication, problem-solving and corrective-action abilities.

Responsibilities

• Oversee day-to-day MES claims operations ensuring timely and accurate processing, adjudication, and resolution of Medicaid claims.
• Provide leadership support and counsel to operations management and cross-functional teams.
• Lead change management and reporting to optimize SLAs and resource use.
• Manage Provider Enrollment operations and NCQA CVO related activities.
• Coordinate internal/external audits, business continuity and quality assessments.

Skills

Medicaid Operations Leadership

Project Management

Provider Enrollment Management

NCQA CVO knowledge

Communication skills

SharePoint

Excel

PowerPoint

PMO

Tableau/Power BI

CMRS (Six Sigma)

Education

Bachelor's Degree in related discipline

Tools

Tableau

Power BI

Job description

At General Dynamics Information Technology (GDIT), we support state agencies in streamlining Medicaid Enterprise Systems (MES) by delivering operational efficiency and excellence. We are seeking a Claims Operations Manager to oversee and optimize the day-to-day MES claims processing operations under the Fiscal Agent Operations function. This role involves managing the processing, adjudication, and resolution of healthcare claims for Medicaid beneficiaries while ensuring operational compliance and consistent service delivery.

As the Claims Operations Manager, you will lead a team responsible for ensuring that Medicaid claims processing operations meet performance standards, comply with state and federal regulations, and deliver a high degree of accuracy and timeliness.

Responsibilities

• Manage and oversee day-to-day MES claims operations, ensuring timely and accurate processing, adjudication, and resolution of Medicaid claims according to guidelines and contractual Service Level Agreements (SLAs).
• You will act as a thought partner to the leadership team to provide support and counsel for operations management, communications, initiatives and projects.
• You should be a self-starter with outstanding organization and communication skills; fast-paced environment.
• Understand strategic financials regarding areas of oversight.
• Proven ability to build strong partnerships with colleagues, desire to be flexible and think proactively, strategically, and analytically about diverse business solutions and leading professional working groups.
• Ability to make critical decisions with limited guidance while ensuring visibility into those decisions.
• A demonstrated understanding of Medicaid support operations and an appreciation for how to prioritize among demands and balance the levers that make a complex business run smoothly and productively.
• Manages Provider Enrollment operations for the program, including optimizing resources to facilitate SLA deliverables and maximize efficient operations.
• Manages change management efforts and reporting to optimize SLAs and ensure optimization of resources.
• Serve as lead cross departmental deliverables for operations, including internal and external audits, business continuity, and other program operations deliverables.
• Serve as a resource for operational managers and assist with training and mentoring operational managers regarding key operational processes.
• Lead cross departmental operational efforts for internal and external quality assessments, audits and surveys.
• Lead cross departmental communication initiatives to both internal and external stakeholders, including community engagement efforts and efforts to facilitate employee engagement.
• Manage and oversee key departments, including training and operational data efforts to optimize efficiencies and ensure effective operations.
• Oversee and coordinate NCQA CVO efforts and all supporting efforts.
• Manages and optimizes customer and key stakeholder relationships, including escalations and developing processes to facilitate timely management of provider enrollment related escalations.

Required Skills and Qualifications

• Education: Bachelor's Degree in related technical, scientific, business, health or a related discipline
• Required Experience: 5+ years of related experience
• Required Skills and Abilities: Medicaid Operations Leadership Support , Project Management Skills, Provider Enrollment Management Skills and Experience, NCQA CVO knowledge and experience.
• Demonstrated ability to communicate issues, impacts, and corrective actions
• Preferred Skills: SharePoint, Excel, PMO, PowerPoint
• Strong knowledge ofMedicaid Fee-for-Service (FFS), and Managed Care claims processes.
• Experience with healthcare claims software platforms and operational workflows.
• Experience inclaims repricingand interaction with national coding standards (e.g., CPT, ICD-10, HCPCS).

Preferred Qualifications

• Familiarity with Program Integrity (PI) workflows, fraud/waste/abuse detection, and encounter data validation.
• Proficiency with claims adjudication systems, reporting tools, and analytics platforms like Tableau or Power BI.
• Familiarity with Medicaid Information Technology Architecture (MITA) and CMS certification processes.
• Highly desirable certifications such asCertified Medical Reimbursement Specialist (CMRS)or lean process improvement certifications (e.g., Six Sigma).

Additional Information:

Work Arrangements: Hybrid, based in the Montgomery, AL area. Expect to be in office at least one day a week. Travel outside the area may be required.

Security: A background check will be required.

Timeline: This is a contingent job posting. Work is not expected to begin until AUGUST 2026 or later.

Work visa sponsorship will not be provided for this position.

GDIT IS YOUR PLACE

• Growth: AI-powered career tool that identifies career steps and learning opportunities
• Support: An internal mobility team focused on helping you achieve your career goals
• Rewards: Comprehensive benefits and wellness packages, 401K with company match, and competitive pay and paid time off
• Flexibility: Full-flex work week to own your priorities at work and at home
• Community: Award-winning culture of innovation and a military-friendly workplace

OWN YOUR OPPORTUNITY

Explore an enterprise IT career at GDIT and you’ll find endless opportunities to grow alongside colleagues who share your desire to drive operations forward.